MEDICARE: UNIVERSITY PRIMARY CARE PRACTICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		OH

General Provider Information

NPI Number	:	1669673612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PRIMARY CARE PRACTICES INC

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	440-684-1769
Fax Number	:	440-684-1780

Provider Business Practice Location Address
First Line	:	730 SOM CENTER RD STE 310
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2362
Country	:	US
Telephone Number	:	440-684-1769
Fax Number	:	440-684-1780

Authorized Official
Title or Position	:	DIRECTOR OF BILLING SERVICES
Name	:	MR. STEVE RIDDLE
Credential	:
Telephone Number	:	216-383-6480

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	04/08/2010

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